From the Research
Lomotil (diphenoxylate/atropine) is generally considered safe for patients with G6PD deficiency, as it does not appear to cause oxidative stress to red blood cells, which is the mechanism by which certain drugs precipitate hemolysis in G6PD deficiency. The active ingredients in Lomotil work primarily on the gastrointestinal tract to reduce intestinal motility. When prescribing Lomotil for patients with G6PD deficiency, standard dosing can be used: for adults, typically 2 tablets (5 mg diphenoxylate/0.05 mg atropine) 3-4 times daily until diarrhea is controlled, then reducing to maintenance dosing. However, as with any medication, it's essential to monitor patients for unusual symptoms such as jaundice, dark urine, or fatigue that might indicate hemolysis, although this would be unexpected with Lomotil 1.
Some key points to consider when prescribing Lomotil to patients with G6PD deficiency include:
- Monitoring for signs of hemolysis, such as jaundice, dark urine, or fatigue, although this is unlikely with Lomotil 2
- Using standard dosing for adults, with adjustments as needed to control diarrhea 3
- Being aware of the potential for other medications to trigger hemolysis in G6PD-deficient patients, and avoiding those medications when possible 4
- Recognizing the importance of screening for G6PD deficiency in patients who may be at risk, and educating them on how to avoid triggers that can lead to hemolysis 5
It's also important to note that the most recent and highest quality study on this topic, published in 2024, found that many medications previously thought to be risky for G6PD-deficient patients were actually prescribed safely to these patients without causing hemolysis 1. This study provides reassurance to patients, prescribers, and regulators, and suggests that Lomotil can be used safely in patients with G6PD deficiency.